Korean J Gastroenterol.  2019 Jul;74(1):42-45. 10.4166/kjg.2019.74.1.42.

Rapunzel Syndrome Removed with Enteroscopy in a Child

• Chun SW
• Lee K
• Park YJ
• Shin HD

• KMID: 2453257
• DOI: http://doi.org/10.4166/kjg.2019.74.1.42

Abstract

A trichobezoar is a type of bezoar that is composed of hair. In most cases, it is confined to the stomach, but in rare cases, it may extend to the small intestine. This condition is referred to as Rapunzel syndrome. The therapeutic method for bezoar removal depends on its type, location, and size. Generally, the treatment for Rapunzel syndrome involves surgical laparotomy. Endoscopic removal has also been effective in some cases. On the other hand, complications, such as respiratory difficulty and esophageal impaction may be encountered during endoscopic removal. Until now, the successful endoscopic removal of trichobezoars has been limited to the stomach or duodenum. This paper reports the case of a 4-year-old female patient with Rapunzel syndrome whose trichobezoar reached the proximal jejunum. The trichobezoar was removed without complications using an electrosurgical knife and snare through a single-balloon enteroscopy. The trichobezoar can be removed successfully using enteroscopy under general anesthesia without abdominal laparotomy in young children. Therefore, this method of removal can be considered preferentially for children with Rapunzel syndrome.

Keyword

Bezoars; Single-balloon enteroscopy; Child

MeSH Terms

Anesthesia, General
Bezoars
Child*
Child, Preschool
Duodenum
Female
Hair
Hand
Humans
Intestine, Small
Jejunum
Laparotomy
Methods
SNARE Proteins
Stomach
SNARE Proteins

Figure

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  Fig. 1 Abdomen computed tomography scan pictures of (A) and (B) show that the bezoar-like materials are found in the stomach and jejunum (yellow arrows) with mucosal thickening.

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  Fig. 2 Endoscopic findings. (A) The picture shows the trichobezoar passing through the pylorus in the stomach. (B) The picture shows the trichobezoar pressing the mucosa of the proximal jejunum.

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  Fig. 3 Endoscopic procedure and removed trichobezoar. (A) The process of cutting the trichobezoar with an ITknife2 electrosurgical knife in the stomach. (B) The trichobezoar is removed using a snare in the stomach. (C) The removed trichobezoar pieces.

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